Despite a heavy lobbying effort, the Obama administration declined to include autism therapy in final rules this week defining what must be covered by insurers under health care reform.

Many states have established mandates in recent years requiring at least some health insurance plans to include coverage of behavior therapy to treat autism. But with the passage of the 2010 health care reform law, advocates were hopeful that a nationwide standard would be established.

Under the federal law, most health insurance plans will be required to cover 10 so-called “essential health benefits” starting next year, one of which is “mental health and substance use disorder services, including behavioral health treatment.”

Autism advocates urged regulators to include a requirement that applied behavioral analysis, or ABA therapy, be covered in rules governing what exactly qualified as a “behavioral health treatment,” but a final rule issued this week makes no mention of the treatment. Read more here.

In the continuing media coverage of private entities making arbitrary decisions about care for children....

By Carol Marbin Miller

cmarbin@MiamiHerald.com

The 16-year-old girl is being raised by the state because she was repeatedly molested, first by her father and, later, by her grandfather. She has endured so much anguish that she has been diagnosed with the same illness as many combat veterans, post-traumatic stress disorder.

Her therapists say she desperately needs residential psychiatric care. State healthcare administrators refuse to pay for it undefined saying she is a drug addict, not a child in need of mental healthcare.

In the latest clash between Florida’s embattled healthcare agency and children’s advocates, Miami-Dade Circuit Judge Michael Hanzman is accusing the Agency for Health Care Administration of concocting misleading mental health evaluations to avoid providing basic and necessary services for children in state care.

“This court has been increasingly concerned that dependent children are being denied much-needed treatment for mental health disorders undefined contrary to the first stated purpose of [child welfare law], which is to provide for the care, safety and protection of children,” Hanzman wrote.

The three children in Hanzman’s 38-page, Feb. 1 order are among about 19,000 in state care.

AHCA already has drawn harsh criticism in recent months over claims it is cutting in-home care to severely disabled children so deeply that many parents have no choice but to warehouse their children in geriatric nursing homes.

In that case, as in Hanzman’s order, advocates claim the healthcare agency is paying a private company to justify sometimes deep cuts in services to the most needy.

In both cases, the agency has been accused of employing arbitrary criteria to produce the result it desires: spending fewer dollars to provide care.

Note -- one of our Alliance members, Grizzy Miller is quoted in the article!

Miami Herald

After months of intense criticism, Florida healthcare regulators have quietly announced new rules that could enable hundreds, perhaps even thousands of Floridians to raise their disabled children at home rather than place them in institutions.

The biggest change: The state will no longer require that parents undefined and sometimes teenage siblings and grandparents undefined perform complex medical tasks “that normally could only be provided by a licensed nurse.” Such medical procedures might include the tube-feeding of children, the suctioning or replacement of breathing tubes and the oversight of ventilators.

Instead, a trained professional would provide the services, with the state footing the bill.

The revisions by the Agency for Health Care Administration may help parents of disabled children another way: The agency also loosened its policies governing medical daycare centers, which offer parents an opportunity for their children to receive nursing care undefined and, often, an education undefined while their parents work during the day. Under the new changes, parents need not be at an eight-hour job for their children to be eligible for services at the medical centers.

“This is wonderful news,” said Grizzy Miller, president of a company, Pedi Pec, that operates medical daycares in Miami-Dade and Broward counties. Miller called “unjust” the AHCA policies that had “unfairly impacted dozens of families who were not deemed eligible for [daycare] services over the past several years.”

TALLAHASSEE – Low-income Floridians, small businesses and mega health care companies are all waiting on Tallahassee lawmakers to decide how and when the state will implement the Obama administration's signature accomplishment – the Affordable Care Act.

Lawmakers last week spent hours debating some of the major questions on implementation. The biggest issue is whether to expand Medicaid eligibility to add roughly 1 million people to the 3.3 million people now enrolled in the federal-state program – and that's not close to resolution.

Like many franchisees, Robert U. Mayfield, who owns five Dairy Queens in and around Austin, Tex., is always eager to expand and undefined no surprise undefined has had his eyes on opening a sixth DQ. But he said concerns about the new federal health care law had persuaded him to hold off.

“I’m scared to death of it,” he said. “I’m one of the ones sitting on the sidelines to see what’s really going to happen.”

Mr. Mayfield, who has 99 employees, said he was worried he would face penalties of $40,000 or more because he did not offer health insurance to many of his full-time workers undefined generally defined as those working an average of 30 hours a week or more. Ever since the law was enacted in 2010, opponents have argued that employers who were forced to offer health insurance would lay off workers or shift more people to part-time status to compensate for the additional cost. Those claims have drawn considerable attention undefined and considerable anger in response undefined in recent weeks.

TALLAHASSEE, Fla. (AP) undefined Florida Gov. Rick Scott, one of the most vocal critics of the federal health care overhaul, is dropping his staunch opposition to the law.

Scott said in an interview Tuesday with The Associated Press that he now wants to negotiate with the federal government. He said it's time for Republicans to offer solutions to help families after they lost their bid to defeat President Barack Obama.

"The election is over and President Obama won," Scott said. "I'm responsible for the families of Florida ... If I can get to yes, I want to get to yes."

Scott had previously stated that he would not go along with any parts of the health care overhaul that the state controls.

But his newfound willingness to have a "conversation" about putting it in place in Florida comes at a critical time.

States have until Friday to notify federal authorities whether they plan to set up health insurance exchanges, a marketplace where individuals and smalls businesses can shop for the most affordable coverage and where many will get help from the government to pay their premiums.

Gov. Rick Scott doubled down that he could outlast Obamacare. He lost.

Tuesday's re-election of President Barack Obama, along with the return of a Democratic-led Senate, guarantees the Affordable Care Act will keep moving forward, including here in Florida, where Scott has been among its staunchest opponents.

Scott placed his bet just days after the U.S. Supreme Court upheld the law in June, saying Florida wouldn't implement two key provisions: the expansion of Medicaid for poor adults and the creation of a state-run marketplace where residents shop for and buy commercial health insurance policies.

He was confident Republican presidential nominee Mitt Romney would win the election and promptly repeal the contentious law. But experts from both sides say Obama's win -- and wide voter sentiment that there should be an end to partisan bickering -- will force Scott, Florida's Legislature and the U.S. Congress to seriously address health care reform.

23 Oct 2012 5:57 PM |
Anonymous

By Jim Saunders, The News Service of Florida

THE CAPITAL, TALLAHASSEE, October 23, 2012.......After years of back-and-forth legislative debates about the Medically Needy program, the state is preparing to ask federal officials to approve putting the program's tens of thousands of beneficiaries into managed-care plans.

The Agency for Health Care Administration is expected Nov. 26 to submit what is known as a "waiver" application to the federal government. The Medically Needy program serves people who don't qualify financially for the Medicaid program but have costly and debilitating conditions, such as being organ-transplant recipients.

Lawmakers in 2011 approved a sweeping proposal to put almost all Medicaid beneficiaries into HMOs or other types of managed-care organizations. That measure also called for using managed care in the Medically Needy program, and the new waiver application would carry that out.

It remains unclear when --- or even if --- the federal Centers for Medicare & Medicaid Services will approve the Legislature's plans to transform Medicaid. The state in August 2011 submitted two other Medicaid managed-care waiver applications to federal officials, but the proposals still have not been approved.

Earlier this year, AHCA submitted a waiver application to the federal government that would lead to Medically Needy beneficiaries enrolling in what are known as "provider-service networks,'' a form of managed care. That proposal, which also remains pending, would be a "bridge" to the broader use of managed care, said David Rogers, AHCA's assistant deputy secretary for Medicaid health systems.

AHCA on Tuesday held the second of two public hearings that are needed before the Medically Needy request can be submitted. Only officials from the Florida Hospital Association and the Florida Council of Advance Practice Nurses spoke during the hearing.

The Medically Needy program has long drawn heavy debate in Tallahassee, as lawmakers have looked for ways to hold down health-care costs. While the program serves an average of 48,158 people a month, it had estimated costs last fiscal year of $938.6 million, according to information provided at the hearing.

Hospitals have particularly been concerned about cost-cutting proposals in the Medically Needy program. The industry worries, at least in part, that it will get stuck with large amounts of uncompensated care because people with debilitating conditions will need hospital treatment --- regardless of whether the state helps pay for it.

Patient advocates also have been concerned that changes will force Medically Needy beneficiaries to pay larger shares of their medical costs. Under the managed-care proposal, beneficiaries would pay premiums, which one AHCA document estimates would be about $118 a month.

Rogers said the move to managed care is aimed at helping better coordinate services and care for the beneficiaries, which could help hold down costs. As an example, they would be able to continue getting coverage for up to 12 months if they pay the premiums. Currently, they have to qualify each month.

22 Oct 2012 4:47 PM |
Anonymous

By Michelle Diament, Disability Scoop
October 18, 2012
Some 12,000 special education teachers and aides could lose their jobs in the coming months unless Congress acts to stop impending cuts, according to a new report from Congressional Democrats.

The warning is the latest from lawmakers on the impact likely to be felt from a series of automatic federal spending reductions expected to take effect Jan. 2 under a process known as sequestration. The cuts undefined totaling more than $100 billion undefined were triggered after lawmakers failed to reach a budget deal last year.

The White House estimates that special education alone would lose more than $1 billion under the plan, which calls for most federal programs to be slashed by at least 8.2 percent.

The latest report from Democrats in the U.S. House of Representatives’ Appropriations Committee suggests that the projected staffing reductions could affect over 500,000 students with disabilities.
While members of both political parties have expressed concern about the spending rollbacks, no action on the issue is expected until members of Congress return to Washington following the Nov. 6 election.

19 Oct 2012 9:24 AM |
Anonymous

It can be very difficult to sort fact from fiction, especially in an issue that's as complicated as the Affordable Care Act. Democrats charge that Republicans are wanting to repeal it so they can receive tax funded healthcare for life. Of course, Republicans deny this. And, depending upon the source, both are right.

The New York Times published an article that looks at both sides, click here for the complete article.